Rick Abbott

Loculated ventricles and isolated compartments in hydrocephalus: their pathophysiology and the efficacy of neuroendoscopic surgery.

The neuroendoscopic procedures applied inpatients with isolated compartments, including IUH, LV, IFV, IRF, and multiloculated ventricles were foramen of Monro reconstruction, septostomy, septal wall removal, cyst wall fenestration, fourth ventriculostomy, and endoscopic shunt placement. It was found that the operative goal, creating a state of arrested hydrocephalus, could be achieved by communicating the trapped space to the rest of the ventricular system, opening the ventricular isolation. The associated hydrocephalus could not always be managed endoscopically, however, and shunting of the ventricular system was frequently required, especially in infants. This may be because of the immaturity of the subarachnoid CSF dynamics in infants. What does seem to be logical is to continue to consider managing these conditions with the assistance of the endoscope.

The endoscopic management of arachnoidal cysts

I have little doubt that most arachnoidal cysts will be managed endoscopically in the future given the advances we have seen over the last decade in our instrumentation. Our excitement to employ this new technology should be governed by the reality that we are still learning and that our current success rate is not quite as good as what can be expected when using microneurosurgery.

Craniocerebral disproportion: a topical review and proposal toward a new definition, diagnosis, and treatment protocol

IntroductionAt some point in their lives, patients previously shunted for hydrocephalus may experience chronic, debilitating headaches, despite the fact that their shunts are functioning properly. Previously published reports have suggested that a subset of these patients may be suffering from an iatrogenic craniocerebral disproportion (CCD) and, therefore, may benefit from procedures that expand the available intracranial space. A unified definition of this disorder, however, is lacking.DiscussionHere, the authors chart the history (including historical terminology) of CCD, review its incidence, describe its signs, symptoms, and associated radiologic findings, and expound upon its pathophysiology. Next, a concise clinical definition of CCD based on the temporal correlation of headaches with the appearance of plateau waves on intracranial pressure (ICP) monitoring is proposed. The authors conclude with a discussion of the various therapeutic strategies employed previously to treat this disorder and present their individualized treatment strategy based upon the simultaneous utilization of ICP monitors and gradual external cranial vault expansion.

Intraoperative neurophysiologic monitoring: its impact on the practice of a pediatric neurosurgeon

IntroductionFrom its introduction in the early 1970s, intraoperative neurophysiological monitoring has evolved into an extremely useful and reliable adjunct for operating on the central and peripheral nervous system.ObjectiveThis manuscript reviews the author’s experience with its evolution in his practice and how it impacts it today.

The use of physiological mapping and monitoring during surgery for ependymomas.

IntroductionThe use of intraoperative physiological monitoring has become increasingly common over the last decade and it is a useful tool to be employed for the resection of ependymomas of the central nervous system.DiscussionThis manuscript reviews the history of its development and its methodology with a particular emphasis on those aspects of particular importance during surgery on ependymomas.

Editorial on "The management of childhood hypertonia"

We, as pediatric neurosurgeons, are increasingly involved in the management of childhood hypertonia or elevation in muscle tone. As with any disease that we are called upon to treat, it is important that we understand the etiology of the hypertonia, its different manifestations and that we employ accepted tools to quantify the impact of our treatments on our pediatric patients. This special edition of Child’s Nervous System is devoted to the various treatment options that can be employed in the management of childhood hypertonia. You will find discussions by some of the world’s leading experts in these treatments and in managing such children.

Diffusion Tensor Imaging in chronically shunted patients.

Chronically shunted patients with functioning shunts are often characterized as having slit or smaller than normal ventricles and chronic headaches. In this study, we used Diffusion Tensor Imaging (DTI) to quantitatively analyze the directionality of water diffusion in the internal capsule (IC) and the corpus callosum (CC) in these patients which have been shown to be affected in untreated hydrocephalus patients [1].

Brain tissue viscoelasticity in chronically shunted patients with headaches using Magnetic Resonance Elastography.

Chronic headaches are a well-documented complaint of shunted hydrocephalic patients. However, it is also one of the signs of shunt malfunction. Cranial compliance deficiency may be a cause of chronic headaches in some chronically shunted patients with functioning shunts (often with slit or smaller than normal ventricles). This study aims to use a novel, non-invasive imaging technique, Magnetic Resonance Elastography (MRE) to investigate the role of brain viscoelasticity in pediatric hydrocephalic patients.

The International Society for Pediatric Neurosurgery: our mission under challenge

The past 2 years have been two of the most memorable of my life. It was a humbling experience to be elected President-Elect at our Taipei meeting in 2006 and to then receive the poncho in 2007. And, it was a joyous experience to work with what has to have been one of the most talented and industrious executives in the history of the International Society for Pediatric Neurosurgery (ISPN). These are memories I will always cherish. I thank you for the honor of letting me work for an organization that is so good and that I care so much about. In 1972, 11 neurosurgeons assembled in Chicago and agreed to form the ISPN. The energy for this stemmed from a belief that in order to insure a rapid evolution of our specialty, a sharing of the collective knowledge was mandatory. This type of communication has always been at the core of the ISPN′s activities, and in 2000, our then president Hal Rekate led us in putting this mission on paper (Fig. 1). Our mission is the promotion of health in our young patients. We are no different than other specialties caring for children. We are passionate to further our specialty, and the energy for this comes from our love of children and our desire to serve them well. We take time away from our families to study, we spend our money to travel to learn new techniques, and we sacrifice our time to educate others. To accomplish these tasks, we have traditionally used our printed journals, annual scientific meeting, and educational courses held around the world. These tools were developed in response to the realities of the mid-twentieth century and have been very successful in driving the expansion of our specialty. The ISPN welcomes new members every year, and the attendance at our annual meeting continues to grow. The number and sophistication of the presentations at our annual meeting continues to expand. We are challenged by people such as Archbishop Tutu and the needs of emerging societies in Africa, Asia, and the Americas to support the development of pediatric neurosurgery in their communities. We need to congratulate ourselves on the great strides we have taken toward meeting our mission. But, before we do, before we sit back and reflect on our accomplishments, we had better take a good hard look at what is happening in our world. I do not need to tell you that it is rapidly changing. Therefore, I feel that it is timely for the ISPN to reflect on our mission and how we can support the needs of societies where our specialty is not fully developed. When we look at our world, we are seeing a rapid equilibration in access to information. This has been due to the emerging world′s rising capacity for wealth generation (Fig. 2) [1]. While for the past 400 to 500 years, a small handful of countries with relatively small populations dominated the world economy and controlled access to much information, this is rapidly changing as nations with massive populations experience staggering rates in the growth in their economies. India and China, the prime examples of these phenomena, have liberated much of their economies, and they now function in a largely free-market environment. The result is a freer access to information and the generation of wealth. The key here is the freeing of their economies from state control, and this lesson is being learned in other emerging countries such as Brazil and Childs Nerv Syst (2009) 25:1157–1161 DOI 10.1007/s00381-009-0929-0